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Moser PO, Favier V, Raingeard I, Crampette L, Rigau V, Boetto J. Primitive pituitary perivascascular epithelioid cell tumor: A challenging diagnosis of melanocytic pituitary lesion. Neurochirurgie 2023; 69:101394. [PMID: 36502879 DOI: 10.1016/j.neuchi.2022.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perivascular Epithelioid cell tumors (PEComa) are rare mesenchymal tumors. They generally occur in the gynecologic or digestive tract. The diagnosis of Central Nervous System PEComa is exceptional and challenging. CASE DESCRIPTION We report the case of a 46-year-old woman, with no particular medical history, who presented a secondary amenorrhea and a slight hyperprolactinemia. She was diagnosed on MRI with a pituitary tumor showing spontaneous hypersignal in T1-weighted images. After failure of medical treatment with cabergoline, surgical resection was required due to progressive tumor growth. Macroscopic aspect and initial immunohistochemical features were in favor of a primitive hypophyseal melanocytoma. However, molecular and transcriptional study through targeted exome- and RNA-sequencing led to the exceptional diagnosis of pituitary Perivascular Epithelioid Cell Tumor (PEComa). Three-years of postoperative radio-clinical follow-up showed an asymptomatic non-evolutive small remnant. CONCLUSION PEComa is an exceptional diagnosis among pituitary tumors. It should be evoked as a potential differential diagnosis in case of primitive melanocytic lesion of the pituitary gland. Specific molecular analysis is mandatory to confirm the diagnosis and exclude differential diagnosis.
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Affiliation(s)
- P-O Moser
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France.
| | - V Favier
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - I Raingeard
- Department of endocrinology, Montpellier University medical center, Lapeyronie Hospital, Montpellier, France
| | - L Crampette
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - V Rigau
- Department of pathology, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - J Boetto
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
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Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, Fakhry N, Albert S, Andry G, Babin E, Bach C, Badet JM, Badoual C, Baglin A, Banal A, Barry B, Baudin E, Baujat B, Bensadoun R, Bertolus C, Bessède JP, Blanchard D, Borel C, Bozorg-Grayeli A, Breheret R, Breton P, Brugel L, Calais G, Casiraghi O, Cassagnau E, Castillo L, Ceruse P, Chabolle F, Chevalier D, Chobaut J, Choussy O, Cosmidis A, Coste A, Costes V, Crampette L, Darrouzet V, Demez P, Dessi P, Devauchelle B, Dolivet G, Dubrulle F, Duflo S, Dufour X, Faivre S, Fakhry N, Ferron C, Floret F, de Gabory L, Garrel R, Geoffrois L, Gilain L, Giovanni A, Girod A, Guerrier B, Hans S, Herman P, Hofman P, Housset M, Jankowski R, Jegoux F, Juliéron M, Kaminsky MC, Kolb F, St Guily JL, Laccoureye L, Lallemant B, Lang P, Lartigau E, Lavieille JP, Lefevre M, Leroy X, Malard O, Massip F, Mauvais O, Merol JC, Michel J, Mom T, Morinière S, de Monès E, Moulin G, Noel G, Poissonnet G, Prades JM, Radulesco T, de Raucourt D, Reyt E, Righini C, Robin YM, Rolland F, Ruhin B, Sarroul N, Schultz P, Serrano E, Sterkers O, Strunski V, Sudaka A, Tassart M, Testelin S, Thariat J, Timochenko A, Toussaint B, Coste EU, Valette G, Van den Abbeele T, Varoquaux A, Veillon F, Vergez S, Wassef M. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases. Eur J Surg Oncol 2021; 47:1376-1383. [DOI: 10.1016/j.ejso.2020.11.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
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Sasso M, Barrot A, Carles MJ, Griffiths K, Rispail P, Crampette L, Lallemant B, Lachaud L. Direct identification of molds by sequence analysis in fungal chronic rhinosinusitis. J Mycol Med 2017; 27:514-518. [PMID: 28827018 DOI: 10.1016/j.mycmed.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Fungi are widely implicated in chronic rhinosinusitis. Direct microscopic examination (DME) is used to confirm the biological diagnosis of fungal rhinosinusitis (FRS). Diagnostic sensitivity of DME is better than culture, however DME does not allow fungal species identification. In this study, we included 54 sinus samples demonstrating hyphae on DME. Direct sequencing was compared to culture for the identification of the fungal species. Sequence analysis identified fungi in 81.5% of cases while culture was positive in only 31.5%. The most common genus was Aspergillus and the identified species belonged to section Fumigati or to section Flavi. Among other fungi identified by sequence analysis, Schizophyllum commune was present in three samples attesting to the importance of this Basidiomycetes in FRS. Our results clearly demonstrate the superiority of sequencing compared to culture when performed on specimens with hyphal elements at DME, and contributes to the epidemiological knowledge of fungi involved in FRS.
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Affiliation(s)
- M Sasso
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - A Barrot
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - M-J Carles
- Laboratoire de virologie, CHU de Nîmes, Nîmes, France
| | - K Griffiths
- Service biostatistique et technologies de l'information et de la communication, AP-HM, hôpital de la Timone, Marseille, France
| | - P Rispail
- Département de parasitologie-mycologie, CHU de Montpellier, Marseille, France
| | - L Crampette
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Montpellier, Marseille, France
| | - B Lallemant
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Nîmes, Nîmes, France
| | - L Lachaud
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France.
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Mortuaire G, Michel J, Papon JF, Malard O, Ebbo D, Crampette L, Jankowski R, Coste A, Serrano E. Specific immunotherapy in allergic rhinitis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:253-258. [PMID: 28684084 DOI: 10.1016/j.anorl.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.
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Affiliation(s)
- G Mortuaire
- Inserm U995, service d'ORL et de chirurgie cervicofaciale, Lille Inflammation Research International Center, université de Lille, hôpital Huriez, CHU de Lille, 59000 Lille, France.
| | - J Michel
- Service d'ORL et de chirurgie cervicofaciale, CHU Hôpital La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - J F Papon
- Service d'ORL et de chirurgie cervicofaciale, Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - O Malard
- Service d'ORL et de chirurgie cervicofaciale, CHU de Nantes, 44000 Nantes, France
| | - D Ebbo
- Groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - L Crampette
- Service d'ORL et de chirurgie cervicofaciale, CHU de Montpellier, 34090 Montpellier, France
| | - R Jankowski
- Service d'ORL et de chirurgie cervicofaciale, CHU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - A Coste
- Service d'ORL et de chirurgie cervicofaciale, CHU de Créteil, 94000 Créteil, France
| | - E Serrano
- Service d'ORL et de chirurgie cervicofaciale, CHU de Toulouse, 31059 Toulouse, France
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Bequignon E, Vérillaud B, Robard L, Michel J, Prulière Escabasse V, Crampette L, Malard O, Malard O, Crampette L, Achache M, Alaoui Lamrani Y, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Prulière Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Vérillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:185-189. [DOI: 10.1016/j.anorl.2016.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Escabasse V, Bequignon E, Vérillaud B, Robard L, Michel J, Malard O, Crampette L, Malard O, Crampette L, Achache M, Alaoui Lamrani M, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Pruliere Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Verillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:195-199. [DOI: 10.1016/j.anorl.2016.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Michel J, Prulière Escabasse V, Bequignon E, Vérillaud B, Robard L, Crampette L, Malard O, Malard O, Crampette L, Achache M, Alaoui Lamrani M, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Pruliere Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Verillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). Epistaxis and high blood pressure. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:33-35. [DOI: 10.1016/j.anorl.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Verillaud B, Robard L, Michel J, Pruliere Escabasse V, Béquignon E, Crampette L, Malard O. Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:191-193. [PMID: 27765622 DOI: 10.1016/j.anorl.2016.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior-posterior nasal packing. METHODS A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS Arterial embolization should be performed by an experienced interventional neuroradiologist with adequate technical facilities, to reduce the risk of complications. Cerebral and supra-aortic vessel CT angiography should be performed in case of post-traumatic epistaxis with suspected internal carotid injury. In case of persistent bleeding despite endoscopic hemostasis of the sphenopalatine artery, anterior ethmoidal artery hemostasis should be performed via a medial canthal incision, with endoscopic assistance as needed. In case of persistent epistaxis despite the usual surgical and neuroradiological procedures, surgical exploration of the sinonasal cavities should be performed, with elective coagulation in case of bleeding from secondary branches, and/or ethmoidectomy in case of diffuse bleeding. A decision-tree was drawn up for the management of second-line treatment of epistaxis.
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Affiliation(s)
- B Verillaud
- Service d'ORL, Hôpital Lariboisière, AP-HP, Université Paris 7, 2, Rue Ambroise Paré, 75010 Paris, France.
| | - L Robard
- Service d'ORL, CHU Côte de Nacre, Caen, France
| | - J Michel
- Service d'ORL, APHM CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - V Pruliere Escabasse
- Service d'ORL, Hôpitaux H. Mondor (Assistance Publique Hôpitaux de Paris) et Centre Hospitalier Intercommunal de Créteil, Paris, France
| | - E Béquignon
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
| | - L Crampette
- Service d'ORL, CHU Gui de Chauliac, Montpellier, France
| | - O Malard
- Service ORL, CHU de Nantes, Nantes, France
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Garrel R, Bartolomeo M, Makeieff M, Crampette L, Guerrier B, Cartier C. Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:247-51. [PMID: 27133292 DOI: 10.1016/j.anorl.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction. MATERIALS AND METHOD A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C. RESULTS Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique. CONCLUSION With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C.
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Affiliation(s)
- R Garrel
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
| | - M Bartolomeo
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - M Makeieff
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - L Crampette
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - B Guerrier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - C Cartier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
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Prulière-Escabasse V, Michel J, Percodani J, Serrano E, Gilain L, Crampette L, Jankowski R, Stoll D, de Gabory L. Consensus document for prescription of nebulization in rhinology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:371-374. [DOI: 10.1016/j.anorl.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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Makeieff M, Burcia V, Raingeard I, Eberlé M, Cartier C, Garrel R, Crampette L, Guerrier B. Positron emission tomography–computed tomography evaluation for recurrent differentiated thyroid carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:251-6. [DOI: 10.1016/j.anorl.2012.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 11/16/2022]
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Gari-Toussaint M, Lachaud L, Pihet M, Rispail P, Castillo L, Crampette L, Bouchara JP. Sinusite récidivante due à Schizophyllum commune . À propos de deux nouveaux cas. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Garrel R, Tripodi C, Cartier C, Makeieff M, Crampette L, Guerrier B. Cervical lymphadenopathies signaling thyroid microcarcinoma. Case study and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:115-9. [PMID: 21333620 DOI: 10.1016/j.anorl.2010.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 11/29/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some lateral cervical lymphadenopathies may lead to the discovery of papillary microcarcinomas (PMC) of the thyroid that are not radiologically apparent. This relatively rare clinical situation raises questions about the diagnostic approach to chronic cervical lymphadenopathy and the impact of lymph node metastasis on PMC prognosis. PURPOSE OF THE ARTICLE: To study the epidemiologic, clinical, and prognostic criteria of cases of lymphadenopathy that signaled PMC. PATIENTS AND METHODS A retrospective study of 167 consecutive cases of PMC compared with 13 cases where a cervical mass signaled other forms of PMC. RESULTS The mean age was 48.5 years, the ratio of men to women was 5:8, and the mean PMC size was 5.5mm. These data did not differently significantly from those of the other PMC cases. The preoperative imaging found fluid content in six cases, with microcalcifications in three cases. All cases were treated by modified radical neck dissection on the side with the lymphadenopathy and total thyroidectomy with central neck dissection. The lymphadenopathy included a ruptured capsule in five cases and was accompanied by central lymph node metastases in three cases. Thyroid capsule involvement was significantly more common in cases of PMC discovered due to lymphadenopathy than in other cases of PMC (69% versus 9.7%, respectively; p<0.001). The mean follow-up was 7.3 years. There were no deaths due to PMC signaled by lymphadenopathy. Two cases of lymph node recurrence after 8 and 10 years were controlled by another surgery and radioactive iodine treatment. CONCLUSION Any chronic cervical mass should suggest the possibility of thyroid origin, especially in cases with cystic content or microcalcifications in subjects with no particular risk factors. An ultrasound of the thyroid should be done, as well as a fine needle aspiration biopsy of the lymphadenopathy with a thyroglobulin assay. Treatment is the same as for any thyroid carcinoma, and results in a good oncological outcome, despite the possibility of lymph node recurrences.
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Affiliation(s)
- R Garrel
- Pôle Neuroscience Tête et Cou, Département ORL et Chirurgie Cervico Faciale, CHRU Gui-de-Chauliac, 34280 Montpellier, France.
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Blumen M, Crampette L, Fischler M, Galet de Santerre O, Jaber S, Larzul JJ, Meyer B, Monteyrol PJ, Payen JF, Pételle B, Rugina M, Chabolle F. Traitement chirurgical du SAHOS. Rev Mal Respir 2010; 27 Suppl 3:S157-65. [DOI: 10.1016/s0761-8425(10)70021-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El Ayoubi A, Poizat F, Garrel R, Costes V, Guerrier B, Essakalli L, Kzadri M, Crampette L. Les adénocarcinomes nasosinusiens revisités. Intérêt pronostique de la classification histologique OMS 2005. ACTA ACUST UNITED AC 2009; 126:175-81. [DOI: 10.1016/j.aorl.2009.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 06/04/2009] [Indexed: 11/28/2022]
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Cartier C, Jouzdani E, Garrel R, Makeieff M, Crampette L, Guerrier B. [Study of the platysma coli muscle vascularisation by the facial artery. Implication during the elevation of the musculo-cutaneous platysma coli muscle flap]. Rev Laryngol Otol Rhinol (Bord) 2009; 130:139-144. [PMID: 20345068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. PATIENTS AND METHODS Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. RESULTS The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. CONCLUSION The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.
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Affiliation(s)
- C Cartier
- Hôpital Gui de Chauliac, Service O.R.L et Chirurgie Cervico-Faciale, Av Augustin Fliche, 34090 Montpellier, France.
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Garrel R, Costes V, Drommard M, Barbotte E, Cartier C, Makeieff M, Crampette L, Guerrier B, Maudelonde T, Boulle N. Evaluation of the diagnostic accuracy of RT-PCR quantification of cytokeratin mrna in the detection of sentinel lymph node invasion in oral and oropharyngeal squamous cell carcinoma: A comparison with immunohistochemistry. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Babin E, Borsik M, Braccard S, Crampette L, Darrouzet V, Faure F, Fontanel JP, Houdart E, Jankowski R, Le Clech G, Malvezzi L, Morinière S, Perie S, Perret J, Pignat JC, Portier F, Serrano E, Plauchu H. [Treatments of hereditary hemorrhagic telangiectasia of the nasal mucosa]. Rev Laryngol Otol Rhinol (Bord) 2005; 126:43-8. [PMID: 16080648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
UNLABELLED Hereditary Hemorrhagic Telangiectasia is a systemic autosomal dominant disorder involving blood vessels. The most common symptom is recurrent epistaxis. The treatments of these epistaxis are numerous but such treatments are often symptomatic and their effects are often not sustained. Some of these treatments may be complicated by visceral vascular malformations. The aim of this study is to propose a treatment plan for these patients with hierarchical organisation of therapeutic options taking into account of their previous therapy. METHOD H. Plauchu organized in Paris, december 2002 a meeting with any medical specialists of this disease. They have analysed variety of therapies that have been proposed for epistaxis control in Hereditary Haemorrhagic Télangiectasia. RESULTS Most common use packing of nasal fossa and then hyperselective embolization of the internal maxillary and facial arteries for severe epistaxis. For chronic epistaxis, best treatment use sclerotics products (Ethibloc) and laser. After discussion, primary embolization could be useful to reduce vascularization of nasal fossa. CONCLUSION Treatment of epistaxis in Hereditary Haemorrhagic Telangiectasia could increase in few years. Use of an index card of for epistaxis in the disease of Rendu-Osler could help to find treatment of choice.
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Affiliation(s)
- E Babin
- CHU, Service ORL et de Chirurgie Cervico-Faciale, Avenue de la Côte de Nacre, F-14033 Caen Cedex 1, France.
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19
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Venail F, Crampette L. [Management of chronic cough by the ENT specialist]. Ann Otolaryngol Chir Cervicofac 2004; 121:322-6. [PMID: 15711470 DOI: 10.1016/s0003-438x(04)95529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- F Venail
- Service ORL, CHU Gui de Chauliac, 34000 Montpellier
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20
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Meybeck A, Just N, Heurtebise F, Chanez P, Crampette L, Darras J, Wallaert B. [Involvement of the nasal sinuses in sarcoidosis. A prospective study of 63 patients]. Rev Mal Respir 2004; 21:279-86. [PMID: 15211236 DOI: 10.1016/s0761-8425(04)71286-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sarcoidosis is a diffuse granulomatous inflammatory disorder of unknown aetiology. Involvement of the nasal sinuses has been reported only rarely. METHODS This multicentre prospective study was undertaken on patients suffering from histologically confirmed sarcoidosis between October 2001 and August 2002. It comprised a questionnaire for nasal symptoms, a nasal endoscopy and a CT scan of the nasal sinuses. RESULTS Among the 62 patients enrolled 38 reported at least one nasal sinus symptom. An abnormality of the CT scan was present in 70% of cases. None were specific for sarcoidosis. Rhinoscopy revealed a mucosal lesion in 11 cases. The presence of mucosal nodules on the turbinates was suggestive of sarcoidosis and was proven histologically in 4 cases (6.5%). In these 4 cases there were symptoms of nasal sinus involvement and extensive CT changes. CONCLUSIONS Involvement of the nasal sinuses is rare in the course of sarcoidosis. Anterior rhinoscopy allows diagnosis before the development of typical lesions and also the taking of guided biopsies.
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Affiliation(s)
- A Meybeck
- Clinique des Maladies Respiratoires, Hôpital Albert Calmette, Lille, France
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21
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Piette V, Bousquet C, Kvedariene V, Dhivert-Donnadieu H, Crampette L, Senac JP, Bousquet J, Demoly P. Sinus CT scans and mediator release in nasal secretions after nasal challenge with cypress pollens. Allergy 2004; 59:863-8. [PMID: 15230820 DOI: 10.1111/j.1398-9995.2004.00509.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Involvement of paranasal sinuses has been suggested in allergic rhinitis but not clearly demonstrated. AIMS To investigate the relationship between intermittent allergic rhinitis and computerized tomography (CT). METHODS Twenty patients with intermittent rhinitis and sensitized to cypress pollens underwent unilateral nasal provocation tests (NPTs) using increasing concentrations of cypress pollens out of the pollen season. Sinus CT-scans were carried out just before a NPT and 24 h later. Nasal lavage was carried out just before a NPT, 30 min after a positive challenge and again 24 h later. Leucotriene C4/D4, intracellular adhesion molecule-1 and eosinophil cationic protein were measured in nasal secretions. RESULTS Thirteen patients (65%) showed an alteration in their CT-scans after allergen challenge. Ten of them showed sinus changes controlateral to their allergenic provocation. Radiological changes mainly affected the osteomeatal complex and the ethmoid sinuses. Pre-existing abnormalities (13 of 20 cases) mainly concerned the maxillary sinuses. There was no correlation between CT-scan abnormalities and levels of mediators released in nasal secretions. CONCLUSIONS We have shown that nasal allergen challenge can produce radiological changes in the paranasal sinuses. This mainly concerned the ethmoid sinuses.
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Affiliation(s)
- V Piette
- Maladies Respiratoires, INSERMU454, IFR3, Hôpital Arnaud de Villeneuve, CHU Montpellier, 34295 Montpellier Cedex 5, France
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22
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Raherison C, Montaudon M, Stoll D, Wallaert B, Darras J, Chanez P, Crampette L, Magnan A, Demessi P, Orlando JP, Didier A, Serrano E, Prud'homme A, Meurice JC, Klossek JM, Tunon-de-Lara JM. How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings. Allergy 2004; 59:821-6. [PMID: 15230813 DOI: 10.1111/j.1398-9995.2004.00487.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.
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Affiliation(s)
- C Raherison
- Société de Pneumologie de Langue Française (SPLF) Working Group, CHU-Bordeaux, France
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23
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Venail F, Garrel R, Corpelet D, Mondain M, Makeieff M, Guerrier B, Chanez P, Crampette L. [Nasal involvement in Crohn's disease: report of a case and diagnostic difficulties of systemic diseases affecting the nose]. Rev Laryngol Otol Rhinol (Bord) 2003; 123:179-84. [PMID: 12577784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The authors describe the case of a 32 years old man with Crohn's disease who has developped sinonasal and tracheal localizations. The review of the literature, quite poor, allows to find some cases of nasal involvement in Crohn's disease and few associations between this illness and others systemic diseases as Wegener's disease or relapsing polychondritis. Among these diseases, we can find atypical conditions mixing different features of the most classical systemic diseases, which are called "overlap syndromes". The case we report illustrate these questions relative to the diagnosis. To conclude, it may be important to point at the difficulties of the anatomopathological diagnosis and the interest of the iterative biopsies. Regular follow-up can help us to identify systemic disease with the research of new extra-sinonasal symptoms.
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Affiliation(s)
- F Venail
- CHU Gui de Chauliac, Service ORL A. 80 avenue Augustin Fliche, F-34295 Montpellier, France
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24
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Garrel R, Gardiner Q, Khudjadze M, Demoly P, Vergnes C, Makeieff M, Guerrier B, Crampette L. Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology 2003; 41:91-6. [PMID: 12868374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Between 30 and 50% of patients with sinonasal polyposis (SNP) will require surgical treatment. OBJECTIVE To determine the medium term risks and benefits of endonasal ethmoidectomy in SNP. METHOD 132 cases of SNP have been retrospectively studied before and after endoscopic nasal surgery with a mean follow-up of 5 years. Functional symptoms and appearances on endoscopic examination were recorded on graded scales. Non-parametric statistical analyses for matched series were used in the assessment of data. RESULTS Post-operative normalisation of nasal function was obtained in 62% of cases. Each of the four main nasal symptoms (nasal obstruction, rhinorrhoea, facial pain and anosmia) was improved (p = 0.001). Patients with associated asthma or ASA triad had higher scores for nasal obstruction and rhinorrhoea (Fisher's exact test; p < 0.02). The pre-operative clinical stage of SNP correlated neither with recurrence nor with functional outcomes (Fisher's exact test; p > 0.05). The requirement for steroid treatment of concurrent asthma was also reduced post-operatively (p = 0.001). The association with asthma and its level of treatment was not related to the frequency of recurrence of SNP (Chi2; p > 0.6). CONCLUSIONS Functional outcomes for patients with SNP and asthma were significantly improved by endoscopic surgical treatment, even if the appearance of the nasal mucosa did not always return to normal.
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Affiliation(s)
- R Garrel
- Department of Otolaryngology, CHU Montpellier, France.
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25
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Abstract
BACKGROUND Epidemiological and pathophysiologic studies have shown that allergic rhinitis and asthma often occur in combination. The internationally developed ARIA position paper (Allergic Rhinitis and its Impact on Asthma) recently offered recommendations on allergic rhinitis. As part of this new report and prior to its diffusion, we investigated the management of rhinopathies in asthma patients by pulmonologists in their everyday practice. METHODS From March to June 2000, 477 (48%) French pulmonologists in office-based practice participated in the survey. They were asked to include their first five asthmatic adult patients. In addition to descriptive statistics, univariate and multivariate analyzes were performed. RESULTS We studied 1623 patients with varying severity of asthma (sex ratio 0.9; median age 35 years). The pulmonologists reported rhinopathy in 76.6% of these, with a chronic course in 91%. Among the patients, 67.1% reported rhinopathy. The diagnosis was allergic rhinitis in 66.2% of participants and nasal polyposis in 10.1%. Examination of the nasal cavities was performed by the pulmonologists themselves in 56.2% of patients. Imaging of the sinuses was performed radiographically in 55.3% of enrolled patients and/or by computed tomography in 17.2%. Referral to an ENT specialist occurred for 21.6% of patients, being more common for patients with rhinitis that failed to respond to medical therapy (although some pulmonologists referred their patients routinely). CONCLUSIONS The high prevalence of rhinopathies in asthma patients requires that these conditions are recognized and managed by pulmonologists. Thus, our findings support one of the central messages contained in the new ARIA guidelines-asthma patients should be investigated routinely for rhinitis and other rhinopathies.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires, INSERM U454-IFR3, Hôpital Arnaud de Villeneuve, University of Montpellier, France
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26
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27
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Venail F, Marlier F, Makeieff M, Garrel R, Rhombdane S, Guerrier B, Crampette L. [Combined approach (endoscopic and external) for the treatment of sinusal mucoceles]. Rev Laryngol Otol Rhinol (Bord) 2003; 124:165-70. [PMID: 14725132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
AIM OF THE STUDY Determination of the best surgical approach in the treatment of mucocoeles of the sinuses according to their localization. PATIENTS AND METHODS A retrospective study has been carried out including forty three cases of sinus mucocoeles, surgically treated from 1990 to 1997. These were in descending order, frontal (n = 19), maxillary (n = 10), ethmoïdo-frontal (n = 9), sphenoidal (n = 3) and ethmoidal (n = 2). Surgical treatment was achieved with an exclusive endoscopic approach in 28 cases whereas 15 of them underwent endoscopic surgery associated with an external approach (also called combined technique). Short term complications and recurrence were recorded after a minimum of 6 years follow-up, according to the type of surgery performed and the topography of the mucocoele. RESULTS Recurrence of mucocoeles is prevented in 95.8% of cases by an exclusive endoscopic treatment in ethmoïdo-frontal, maxillary, sphenoidal and ethmoidal sites. On the other hand, the recurrence rate in mucocoeles involving the frontal sinuses without ethmoidal involvement, was significantly higher when the mucocoele was operated on by an exclusively endoscopic method (25%, p < 0.001) rather than by a combined technique (0%). DISCUSSION AND CONCLUSION Ethmoido-frontal, maxillary, sphenoidal and ethmoidal mucocoeles are excellent indications for an exclusively endoscopic endonasal surgery. An external approach, combined with endoscopic surgery, is suitable in frontal mucocoeles, especially in distal sites and in case of recurrence.
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Affiliation(s)
- F Venail
- CHU Gui de Chauliac, Service ORL A, 71 av Augustin Fliche, F-34295 Montpellier, France.
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28
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Carayol N, Vachier I, Campbell A, Crampette L, Bousquet J, Godard P, Chanez P. Regulation of E-cadherin expression by dexamethasone and tumour necrosis factor-alpha in nasal epithelium. Eur Respir J 2002; 20:1430-6. [PMID: 12503700 DOI: 10.1183/09031936.02.00013602] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma and rhinitis often coexist and share many clinical features. The extent of epithelial alteration in nasal inflammation is controversial. Cell-cell adhesion plays an important role in tissue morphogenesis and homeostasis and is mediated by the cadherin family. In human bronchial epithelial cells the authors have shown that tumour necrosis factor (TNF)-alpha induced a significant decrease of E-cadherin and beta-catenin expression. The addition of dexamethasone inhibited this decrease. The aim of the present study was to investigate the effect of TNF-alpha and dexamethasone on the regulation of E-cadherin, gamma-catenin and beta-catenin in human nasal epithelial cells (HNEC). A primary culture of HNEC, obtained from human nasal turbinates after surgery, was used. The quantitative and qualitative modulation of E-cadherin, gamma-catenin and beta-catenin expression was assessed by Western blot and immunofluorescence analysis. In order to assess the TNF-alpha-induced activation of HNEC, interleukin-8 and RANTES (regulated on activation, normal T-cell expressed and secreted) release was assessed by enzyme-linked immunosorbent assay. The results showed that TNF-alpha induced, a decrease in gamma-catenin and beta-catenin expression, but had no effect on E-cadherin expression. Immunofluorescence showed that TNF-alpha induced cytoplasmic localisation of E-cadherin, gamma-catenin and beta-catenin. Dexamethasone inhibited the effect of TNF-alpha and induced a three-fold increase in E-cadherin expression. These results suggest that the difference in nasal and bronchial epithelial cohesion may be due to the differential effect of tumour necrosis factor-alpha and dexamethasone on E-cadherin expression.
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Affiliation(s)
- N Carayol
- Institut National Scientifique et de la Recherche Médicale U454, Clinique des Maladies Respiratoires, Centre Hospitalier Universitaire-Montpellier, Hôpital Arnaud de Villeneuve, Montpellier, France
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29
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Carayol N, Crampette L, Mainprice B, Ben-Soussen P, Verrecchia M, Bousquet J, Lebel B. Inhibition of mediator and cytokine release from dispersed nasal polyp cells by mizolastine. Allergy 2002; 57:1067-70. [PMID: 12359006 DOI: 10.1034/j.1398-9995.2002.23452.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mizolastine is a potent and selective H1-receptor antagonist with antiallergic properties; in in-vitro animal models, mizolastine was shown to inhibit 5-lipoxygenase activity and to decrease the release of leukotrienes (LT) and tumor necrosis factor-alpha (TNF-alpha). This study investigated the effects of three concentrations of mizolastine (0.1, 1.0, 10 microM) on the release of LT (LTB4 and LTC4/D4) and prostaglandin D2 (PGD2) after stimulation by anti-IgE, and on the spontaneous release of cytokines (TNF-alpha and granulocyte/macrophage-colony-stimulating factor [GM-CSF]), from dispersed cells obtained from surgically resected nasal polyps of patients with nasal polyposis. METHODS Cells from nasal polyps were obtained using enzymatic dispersion. For experiments involving the measurement of LT and PGD2, the cells were preincubated with mizolastine or its dissolution vehicle for 20 min prior to challenge with 10 microg/ml epsilon-chain specific anti-IgE for 45 min at 37 degrees C; for the cytokine release, cells were incubated with mizolastine or its dissolution vehicle for 24 h. LT and PGD2 were measured by enzyme immunoassay (EIA) and cytokines by enzyme-linked immunosorbent assay (ELISA) using commercially available kits. RESULTS Mizolastine inhibited significantly and in a dose-dependent manner the release of LTB4 and TNF-alpha at all concentrations, LTC4/D4 at 10 microM, and GM-CSF from 1 microM; no effect was observed on the release of PGD2. CONCLUSION Mizolastine inhibits the release of LT, TNF-alpha and GM-CSF in this in vitro model, which mimics closely the inflammatory cells of allergic rhinitis.
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Affiliation(s)
- N Carayol
- Clinique des Maladies Respiratoires and INSERM U454, Hôpital Arnaud de Villeneuve, Avenue du Doyen G. Giraud, 34295 Montpellier Cedex 5, France
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30
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Crampette L, Serrano E, Klossek JM, Rugina M, Rouvier P, Peynègre R, Bébéar JP, Stoll D. [French multicenter prospective epidemiologic study (ORLI Group) of allergic and lung diseases associated with nasal polyposis]. Rev Laryngol Otol Rhinol (Bord) 2002; 122:231-6. [PMID: 11938522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
224 patients presenting with nasal polyposis (NP) were included in a french prospective multicenter study. NP was evaluated by nasal endoscopy and computed tomography. Allergic status was documented using skin prick-tests and/or specific IgE. Pneumologic assessment included spirometry with carbamyl-choline hyper-reactivity test or beta 2 mimetic broncho-dilation test. Minimal follow up period was 1 year. 45% of the whole population were considered as asthmatic. Asthma onset occurred before and after the NP onset in respectively 45.7%, 22.3% and 32% of cases; these two conditions started simultaneously in 32% of patients. Skin prick-tests and/or specific IgE were positive in 32.5% of cases. In most of the cases (80%), patients were polysensitized to house dust mite and/or pollens and/or animal danders and/or fungi. 31% of the population had idiosyncrasy, caused by drugs in general and especially aspirin in 44% of cases. The global population could be divided in two groups according to the occurrence of previous polypectomy or not. The group "polypectomy" and the group "no polypectomy" were similar regarding the frequency, the age of onset, the course and the severity of associated asthma. Familial history (parents, children, brothers and sisters) was of great interest: 58.7% of the patients had one (or more) relative suffering from NP, 43.6% of the patients had one (or more) relative suffering from asthma and 12.2% of the patients had one (or more) relative suffering from idiosyncrasy. These results support a genetic etiology for NP.
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Affiliation(s)
- L Crampette
- Hôpital Gui de Chauliac, Service ORL et CCF, 2 avenue Bertin Sans, F-34295 Montpellier, France.
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31
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Rugina M, Serrano E, Klossek JM, Crampette L, Stoll D, Bebear JP, Perrahia M, Rouvier P, Peynegre R. Epidemiological and clinical aspects of nasal polyposis in France; the ORLI group experience. Rhinology 2002; 40:75-9. [PMID: 12091997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Nasal polyposis (NP) is a common condition in patients consulting ENT practitioners in France. A multicenter prospective study was performed to evaluate symptoms, demography, environmental factors, personal and family history and associated conditions like asthma, and food or drugs sensitivity (FDS) in patients suffering from NP. In each investigation center assessments were performed at the moment of the initial consultation by the same investigator, then updated with complementary exploration results required by the protocol. The chi 2 test and the Fisher test were used for statistical analysis. In this study 224 patients were included. Males were predominant at 63%. Asthma was found in 45% of cases without relevant sex difference. However, FDS, positive in 31% of the patients, was statistically higher in females than in males (42.9% vs. 24.4%). Severe and major symptoms were more frequently found in the female population. Environment and habitat factors did not appear to be relevant. High rates of NP (52.66%) and asthma (43.58%) were found in the family history. Hereditary factors were suggested and lead us to further study the genetic factors potentially involved in this pathology.
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Affiliation(s)
- M Rugina
- Hôpital Intercommunal, Service ORL, Créteil, France.
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32
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Garrel R, Cartier C, Marvaso V, Corpelet D, Makeieff M, Crampette L, Guerrier B. [Our experience with papillary microcarcinoma of the thyroid]. Rev Laryngol Otol Rhinol (Bord) 2002; 123:239-42. [PMID: 12723489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Papillary microcarcinoma (PMC) of the thyroid gland is high incidence pathology. Most of cases are related to a good prognosis. Conversely, numerous cases are reported with an aggressive course. Prognosis factors are age, size of tumour, multifocality, capsular invasion and cervical lymphadenopathy. MATERIAL AND METHOD We have conduced a retrospective study about 4,208 consecutive thyroidectomies over a period of 16 years. 251 cases of papillary cancers were analysed including 64 PMC (25.5%). RESULTS 90% of PMC were incidentally found and 59% were diagnosed during surgical procedure. Multifocality improved the sensibility of histological diagnosis (P = 0.04). In 78%, total thyroidectomy was performed associated with a selective neck dissection in 47%. In case of extemporaneous diagnosis all partial thyroidectomy was convert into total thyroidectomy. In case of delayed diagnosis and in the absence of unfavourable prognosis factor, no other surgical procedure was carried out. A 7 years mean follow-up revealed only one case of recurrence successfully treated with Iodine 131 ablation. There was no case of death due to PMC. CONCLUSION This study confirms the good prognosis of PMC treated according to usual criterions.
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Affiliation(s)
- R Garrel
- CHU Gui de Chauliac, Service d'ORL et Chirurgie Cervico-Faciale, Rue Augustin Fliche, F-34295 Montpellier, France.
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Crampette L. [Nasal-paranasal sinus polyposis]. Presse Med 2001; 30:44-50. [PMID: 11819912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
UNLABELLED 1. POLYPOSIS AND ALLERGY Nasosinusal polyposis and allergy must be considered as two distinct conditions. 2. POLYPOSIS Approximately 1% of the general population has nasosinusal polyposis, a condition strongly associated with asthma (about one-third of the patients with polyposis have asthma). Patients with nasosinusal should undergo a complete respiratory examination in order to search for asthma or an asthma equivalent. 3. EOSINOPHILS Eosiophils play a crucial role in the inflammatory reaction, releasing almost all the known inflammatory mediators: cytokines, chemokines and growth factors. 4. EPITHELIAL CELL The epithelial cell probably plays a very important role. 5. MEDICAL TREATMENT Long-duration intranasal corticotherapy is the basis of drug treatment. Short courses of oral corticosteroids may be useful during acute episodes in inflammation. The exact effect of oral corticosterid is not clearly elucidated but it is known that non-steroidal antiinflammatory drugs (NSAID) are contraindicated in polyposis. 6. SURGICAL TREATMENT Surgery is reserved for medical failures or for patients with a contraindication for drug therapy. Endonasal ethmoidectomy is the basis treatment. 7. PERSPECTIVES Better understanding of the underlying pathophysiology and the probable genetic component will determine future treatments. Perspectives include antiinflammatory drugs currently reserved for other conditions (antileucotriene, antiTNFa, IL-18) and elaboration of new antiinflammatory drugs.
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Crampette L. [Allergic rhinitis]. Presse Med 2001; 30:41-3. [PMID: 11819911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
UNLABELLED 1. ALLERGY The prevalence of allergy is estimated from 15 to 35%, incidence is on the rise. 2. PATHOGENESIS Allergy is initiated by a very specific IgE-dependent mechanism, but involves a late phase corresponding to non-specific inflammation. 3. SYMPTOMATIC CARE "Modern" antihistamines and local intranasal corticosteroid therapy constitute the basis of symptomatic treatment.
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MESH Headings
- Anti-Allergic Agents/therapeutic use
- Cross-Sectional Studies
- Desensitization, Immunologic
- Humans
- Immunoglobulin E/blood
- Inflammation Mediators/blood
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
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35
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Marlier F, Makeieff M, Gresillon N, Crampette L, Guerrier B. [Laryngomucoceles and subtotal C.H.E.P. reconstructive laryngectomy. Report of 6 cases]. Ann Otolaryngol Chir Cervicofac 2001; 118:110-4. [PMID: 11319412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
UNLABELLED We conducted a retrospective analysis of 131 patients who underwent subtotal CHEP laryngectomy for a tumor of the larynx between 1990 and 1999 in order to determine the incidence of laryngomucocele after surgery. RESULTS Five patients developed laryngomucocele late after surgery. A sixth patient underwent surgery in another unit. Laryngomucocele developed progressively or was disclosed by acute episodes of dyspnea, requiring tracheotomy again in two cases. One patient developed bilateral mucocele. Three patients had cervicotomy, and three others were treated by CO(2) laser endoscopic marsupialization. DISCUSSION We discuss the pathophysiology of late laryngomucocele after subtotal laryngectomy and various techniques that can be used to avoid this complication. CONCLUSION Although exceptional, laryngomucocele generally requires surgical removal by cervicotomy or CO(2) laser endoscopic marsupialization to prevent acute respiratory failure.
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Affiliation(s)
- F Marlier
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital Universitaire Gui de Chauliac, 34000 Montpellier
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Abstract
Intramuscular hemangiomas of the head and neck are rare tumors, sparsely reported. They usually present themselves as a mass which enlarges suddenly. A case of intramuscular hemangioma involving the posterior neck muscles is presented. Computed tomography scanning, magnetic resonance imaging and angiography revealed the vascular nature of this lesion. Surgery consisted of a wide excision. The patient is free of disease after a 4-year follow-up.
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Affiliation(s)
- M Makeieff
- Otolaryngology Head and Neck Surgery Department, Hospital of the University of Montpellier, France
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37
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Demoly P, Bencherioua AM, Crampette L, Dhivert-Donnadieu H, Godard P, Michel FB. [From allergic rhinitis to sinus diseases (sinusitis/nasal polyps): epidemiologic and experimental links]. Rev Mal Respir 2000; 17:925-30. [PMID: 11131870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The relationships between rhinitis and chronic sinusitis are close and complex, those between allergic rhinitis and nasal polyposis are controversial. These relationships can be demonstrated not only in terms of anatomy, physiology and epidemiology (by comparing the prevalence of one disease in patients suffering from the other disease), but also experimentally (by studying the sinus involvement following nasal allergen provocations), and pathophysiologically (by phenotyping and comparing the inflammation present in both diseases). Results of such studies are convincing and have confirmed the fundamental role of nasal inflammation in general and allergic inflammation in particular in the genesis of sinusitis (it is now therefore recommended to utilize the term 'rhinosinusitis'). The importance of allergy in the etiologic development of nasal polyps remains controversal and doubtful. Because the diagnosis of allergic rhinitis provides useful therapeutic options, an appropriate evaluation for underlying allergies in indicated in any patient with chronic upper respiratory tract symptoms.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires, INSERM U454, IFR3, Hôpital Arnaud de Villeneuve, Service d'ORL, Hôpital Gui de Chauliac, CHU de Montpellier.
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38
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Makeieff M, Marlier F, Khudjadze M, Garrel R, Crampette L, Guerrier B. [Substernal goiter. Report of 212 cases]. Ann Chir 2000; 125:18-25. [PMID: 10921180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
AIM OF THE STUDY The aim of this retrospective study was to report the results of the surgical treatment in a series of 210 patients operated on for substernal goiters. PATIENTS AND METHOD From 1982 to 1996, 210 patients with substernal goiters, including 80% of women, were operated on via a cervical approach in 208 cases, via a sternotomy in two cases. Two patients with operative contra-indications were not operated on. Twenty-five were operated on for a substernal recurrence of a goiter. In 160 cases, extraction of the substernal portion was easy. In 48 cases, removal of the substernal portion was facilitated by the discovery of the recurrent nerve at its entering into the larynx and a downward dissection of the tracheal attachments of the lobe. The complete dissection of the cervical portion made easier the ascension of the substernal portion even in very large substernal components. RESULTS Three papillary carcinomas were diagnosed. A transient laryngeal nerve palsy occurred in 7.2% of the patients and a transient hypoparathyroidism in 13.4%, A definitive laryngeal nerve palsy occurred in 1.2% of the patients, and a persistent hypoparathyroidism in 2.1%. Of the 25 patients who underwent surgery for recurrence of a goiter, three (12%) developed a transient laryngeal nerve palsy, one (4%) a permanent nerve palsy, four (20%) a transient hypoparathyroidism and one (4%) a persistent hypocalcemia. CONCLUSION CT scan and MRI are the best explorations to evaluate intrathoracic extension of substernal goiters. Thyroidectomy was performed via a cervical incision in 208 patients and via a sternotomy in two patients only. The complete dissection of the cervical portion with discovery of the recurrent nerve at its entering into the larynx, facilitates the ascension of the substernal portion even in very large substernal goiters.
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Affiliation(s)
- M Makeieff
- Service ORL chirurgie cervicofaciale, hôpital Gui-de-Chauliac, Montpellier, France
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39
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40
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Makeieff M, Youssef B, Gardiner Q, Crampette L, Guerrier B. [Pleomorphic adenoma of the nasal septum: a case report]. Ann Otolaryngol Chir Cervicofac 1999; 116:368-71. [PMID: 10615529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We report on a case of pleomorphic adenoma involving the nasal septum, in a caucasian woman aged 23, who presented with nasal obstruction and epistaxis. A swelling of the anterior part of the nasal septum was observed and a biopsy demonstrated the existence of a pleomorphic adenoma. CT scan and MRI investigation showed the lesion to be limited, and removal was therefore possible using an endonasal approach. No recurrence has been found after 22 months.
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Affiliation(s)
- M Makeieff
- Service ORL et Chirurgie Cervico-Faciale A, Hôpital Gui de Chauliac CHU Montpellier
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41
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Makeieff M, Bosch P, Marlier F, Khudjadze M, Crampette L, Guerrier B. [Imaging of the hypopharynx, oropharynx and parapharyngeal spaces]. Rev Laryngol Otol Rhinol (Bord) 1999; 120:147-54. [PMID: 10544673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Progress in upper aerodigestive imaging improved pathologic staging and therapeutic choices. Imaging, especially CT scan is now indispensable for staging the upper aerodigestive cancers. Some anatomic areas must be explored with special attention because of their importance for therapeutic decision.
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Affiliation(s)
- M Makeieff
- C.H.U. Montpellier, Hôpital Gui de Chauliac, Service ORL et de Chirurgie Cervico-Faciale, France
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42
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Abstract
BACKGROUND Standard treatment of early glottic carcinoma is radiotherapy, but involvement of the anterior commissure leads to a reduced cure rate. We investigated retrospectively whether our modified subtotal laryngectomy had improved results for early glottic carcinomas involving the anterior commissure, without causing excessive disability to laryngeal functions. METHODS Eighty-one patients with T1 or T2 glottic carcinoma involving the anterior commissure were reviewed. Follow-up was at least 3 years. Speech was assessed by subjective evaluation and a computer-assisted voice analysis device. RESULTS Three-year overall survival rate and 3- and 5-year actuarial survival rates were, respectively, 90.1%, 95%, and 90.8%, with no difference between the different T stages involved (p > 0.46). The local recurrence rate was 7.4%. Speech recovered in all patients and was evaluated as satisfactory in 86% of cases. CONCLUSION For early glottic carcinomas involving the anterior commissure, subtotal laryngectomies appear to be more effective than radiotherapy, and our modified technique simplifies the procedure.
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Affiliation(s)
- L Crampette
- ENT Department, Service ORL, Hôpital Saint Charles, Montpellier, France
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43
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Makeieff M, Rubinstein P, Youssef B, Crampette L, Guerrier B. [Repeat surgery for thyroid nodules (excluding cancer and hyperthyroidism)]. Ann Chir 1999; 52:970-7. [PMID: 9951096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Second procedures for recurrent thyroid disease are known to carry a high risk of iatrogenic damage, particularly to the inferior laryngeal nerves and parathyroid glands. This risk has been clearly evaluated for the primary procedure, but is less clearly for second procedures. A series of 117 patients with solitary or multiple cold thyroid nodules were evaluated (excluding those patients re-operated for recurrent thyroid carcinoma or goitre associated with hyperthyroidism) to determine the operative risks. The level of transient and permanent recurrent laryngeal nerve palsy was 2.56% and 1.7% respectively. The level of transient and permanent hypocalcaemia was 12.9% and 4.62% respectively. The frequency of re-operation for recurrent disease involving the pyramidal lobe following total thyroidectomy (6 cases) highlights the importance of removing it during the primary procedure. The number of cases of cancer discovered at re-operation was 4.3% (5 cases out of 117).
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Affiliation(s)
- M Makeieff
- Service ORL et Chirurgie Cervico-Faciale A, CHU Montpellier, Hôpital Saint-Charles
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44
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Makeieff M, Gardiner Q, Mondain M, Crampette L. Maxillary sinus mucocoeles--10 cases--8 treated endoscopically. Rhinology 1998; 36:192-5. [PMID: 9923064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Maxillary sinus mucocoeles are rare, but may cause significant problems outside the sinus including diplopia and cheek swelling. We present 9 patients suffering from maxillary sinus mucocoele, including one patient with bilateral involvement, representing 10 involved sinuses. Eight sinuses were treated endoscopically and followed-up for 3 to more than 6 years; one of these developed a recurrence. Two sinuses were treated using a classical external approach (Caldwell-Luc), one at the beginning of our series, and one as the endoscopic technique was difficult to perform due to loss of anatomical landmarks. One of these two sinuses developed a recurrence and was then successfully treated endoscopically. We discuss the aetiology, pathogenesis and appropriate treatment of this unusual condition. Endoscopic treatment appears to be effective and leads to minimal recurrence. The aim is to perform a wide removal of the medial wall of the maxillary sinus including most of the inferior turbinate, immediately posterior to the lachrymal duct leaving intact the sinus mucosa. In some cases, however, the endoscopic technique can be difficult to perform due to loss of essential anatomical landmarks and in these cases recourse to an external approach may be necessary.
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Affiliation(s)
- M Makeieff
- Service ORL A, Hôpital Saint-Charles, CHU de Montpellier, France
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45
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Makeieff M, Desuter G, Gardiner W, Youssef B, Garrel R, Crampette L, Guerrier B. [Pyolaryngocele: a rare cause of respiratory distress]. Rev Laryngol Otol Rhinol (Bord) 1998; 119:183-5. [PMID: 9770065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pyolaryngocele is an unusual diagnosis, occurring as a complication of a laryngocele, witch may be discovered because of an episode of acute respiratory distress needing urgent medical care. This is a case report with confirmation of the diagnosis by CT scan, which needed surgical treatment.
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Affiliation(s)
- M Makeieff
- Hôpital Gui de Chaujiac, CHU Montpellier, Service ORL, France
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46
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Lebel B, Crampette L, Vergnes C, Campbell AM, Bousquet J. Inhibition of mediator release from dispersed nasal polyp cells by cyclosporin A. Int Arch Allergy Immunol 1998; 116:284-7. [PMID: 9693278 DOI: 10.1159/000023957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The mechanisms of action of cyclosporin A require further elucidation since this drug includes anti-inflammatory properties unrelated to its previously documented effect of T cells. A study was performed using enzymatically dispersed cells from nasal polyps of 7 subjects to examine the effects of cyclosporin A on the release of histamine, leukotriene C4/D4 (LTC4/D4) and thromboxane (TxB2) following stimulation by anti-IgE. Cells were resuspended and preincubated with cyclosporin A (0.1, 1 and 10 microM) or 0.1% DMSO (the vehicle used to dissolve cyclosporin A) for 20 min prior to challenge with 10 microgram/ml epsilon-chain-specific anti-IgE for 45 min at 37 degrees C. Histamine, LTC4/D4 and TxB2 were measured using EIA. Cyclosporin A significantly inhibited the release of histamine, LTC4/D4, and TxB2 in a concentration-dependent manner. IC30 values, histamine (5.1 microM), LTC4/D4 (7.8 microM) and TxB2 (6.2 microM), were determined. These data demonstrate new antiallergic properties of cyclosporin A using a novel in vitro model which mimics more closely allergic inflammation.
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Affiliation(s)
- B Lebel
- Montpellier-Asthme and INSERM U 454, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France
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47
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Demoly P, Sahla M, Campbell AM, Bousquet J, Crampette L. ICAM-1 expression in upper respiratory mucosa is differentially related to eosinophil and neutrophil inflammation according to the allergic status. Clin Exp Allergy 1998; 28:731-8. [PMID: 9677138 DOI: 10.1046/j.1365-2222.1998.00308.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic non-infectious sinusitis is an inflammatory disease sharing numerous features with both allergic and non-allergic rhinitis and asthma. METHODS In an attempt to analyse the underlying mechanisms of sinus and nasal inflammation, we assessed ICAM-1 immunoreactivity on maxillary sinus, nasal polyp and turbinate biopsies obtained surgically from 21 patients with sinusitis and chronic allergic rhinitis (AR), 23 patients with sinusitis and chronic non-allergic rhinitis (NAR) and 17 non-atopic control subjects. We compared ICAM-1 expression with both eosinophil (EG1) and neutrophil (NP57 elastase) infiltrates. RESULTS In nasal turbinates and polyps, ICAM-1 was broadly distributed within the epithelium, on ciliated and basal epithelial cells and in the submucosa on endothelial and inflammatory cells. ICAM-1 was rarely expressed in the mucosa of the sinus, compared with polyps (P < 0.01) and turbinates (P < 0.0001). Submucosal and epithelial eosinophils were increased in both sinus and nasal biopsies from AR by comparison with NAR (P=0.003 and P=0.02) and non-atopic control subjects (P<0.0001 and P=0.014). Submucosal and epithelial neutrophil numbers were increased in the two chronic rhinitis groups and correlated with ICAM-1 submucosal expression in NAR only (P<0.01). On the other hand, epithelial eosinophil numbers correlated with ICAM-1 epithelial expression in AR only (P = 0.002). CONCLUSION This study further characterizes sinus and nasal granulocyte inflammation in chronic non-infectious sinusitis and rhinitis and suggests a differential role for ICAM-1 in neutrophil and eosinophil recruitment according to the allergic status.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires, INSERM U454, Hôpital Arnaud de Villeneuve, Montpellier, France
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48
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Abstract
BACKGROUND Cyclo-oxygenases 1 (Cox-1) and 2 (Cox-2) catalyse the conversion of arachidonic acid to prostaglandin endoperoxides, leading to the formation of prostaglandin and thromboxane mediators of inflammation. The involvement of these enzymes in inflammatory disorders such as sinusitis and nasal polyps is unknown although this may be relevant to their pathophysiology. METHODS We studied Cox-1 and Cox-2 immunoreactivities in nasal polyp, maxillary sinus, and turbinate biopsies obtained from eight patients with chronic allergic rhinitis and sinusitis and/or nasal polyps, 15 patients with chronic non-allergic rhinitis and sinusitis and/or nasal polyps and five control subjects (patients requiring nose surgery not related to sinusitis or nasal polyps). RESULTS Both Cox- and Cox-2 were mainly expressed in the epithelium (basal, ciliated) and were found in 16/28 and 25/28 subjects for Cox-1 and Cox-2 respectively. We did not find any differences between the patient populations. There were no correlations between any of the clinical parameters studied nor the pathological patterns and the presence and characteristics of the Cox immunoreactivities. CONCLUSION Both cyclo-oxygenase enzymes are expressed in normal human upper respiratory epithelium and are not upregulated in chronic sinusitis nor in nasal polyposis, possibly suggesting that Cox products do not have an important role as mediators of the chronic upper airway inflammation.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires - INSERM U454, Hôpital Arnaud de Villeneuve, Montpellier, France
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49
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Demoly P, Crampette L, Mondain M, Enander I, Jones I, Bousquet J. Myeloperoxidase and interleukin-8 levels in chronic sinusitis. Clin Exp Allergy 1997; 27:672-5. [PMID: 9208188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have recently phenotyped inflammation in non-infectious allergic and non-allergic chronic maxillary sinusitis using sinus biopsies and lavage fluids. In this first paper, we have concentrated our work on the eosinophil, T cell, mast cell and macrophage infiltrates. However, many unresolved questions remain and particularly the role of neutrophils needed to be addressed. In the present study, we focused on the neutrophilic inflammation: myeloperoxidase (MPO) and interleukin-8 (IL-8) were measured by immunoassays and neutrophils were enumerated by conventional staining in the sinus lavage fluids of 16 patients with chronic sinusitis and six control subjects. Both MPO and IL-8 levels were significantly higher in patients than in controls (P < 0.01 and 0.005, respectively). There was a significant correlation between MPO levels and neutrophil numbers, and between MPO and IL-8 levels in the sinus lavage fluid (P < 0.0001, Spearman rank correlation). The presence of high levels of IL-8 in the lavage fluids of patients suffering from chronic sinusitis, levels which correlate with those of MPO, suggests that this cytokine may activate neutrophils in this chronic disease.
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Affiliation(s)
- P Demoly
- Maladies Respiratoires-INSERM U454, Hôpital Arnaud de Villeneuve, Montpellier, France
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Abstract
The mechanism of action of H1-blockers requires elucidation because they may possess properties unrelated to the blockage of histamine at its receptor level. A study was performed with enzymatically dispersed cells obtained from nasal polyps to examine the effect of terfenadine (0.1-10 mumol) on the release of leukotrienes (LT) (LTC4/D4 and LTB4) after stimulation by anti-IgE, and on the spontaneous release of cytokines (granulocyte/macrophage-colony stimulating factor [GM-CSF] and tumor necrosis factor-alpha [TNF-alpha]) released from cells cultured for 6 h. Terfenadine inhibited significantly, and in a dose-dependent manner, the release of LTC4/D4, LTB4, TNF-alpha, and GM-CSF. IC50 values were determined for LTC4/D4 (8 mumol), LTB4 (9.9 mumol), TNF-alpha (6.1 mumol), and GM-CSF (4 mumol). Terfenadine was found to possess new antiallergic properties with a novel in vitro model which mimics more closely inflammatory cells of allergic rhinitis or asthma.
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Affiliation(s)
- L Crampette
- Clinique des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France
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